2022

Magnetic resonance imaging before breast cancer surgery: results of an observational multicenter international prospective analysis (MIPA) (2022)

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Type of publication:Journal article

Author(s):Sardanelli F, Trimboli RM, Houssami N, Gilbert FJ, Helbich TH, Álvarez Benito M, Balleyguier C, Bazzocchi M, Bult P, Calabrese M, Camps Herrero J, Cartia F, Cassano E, Clauser P, Cozzi A, de Andrade DA, de Lima Docema MF, Depretto C, Dominelli V, Forrai G, Girometti R, Harms SE, Hilborne S, Ienzi R, Lobbes MBI, Losio C, Mann RM, Montemezzi S, Obdeijn IM, *Ozcan Umit A, Pediconi F, Pinker K, Preibsch H, Raya Povedano JL, Sacchetto D, Scaperrotta GP, Schiaffino S, Schlooz M, Szabó BK, Taylor DB, Ulus ÖS, Van Goethem M, Veltman J, Weigel S, Wenkel E, Zuiani C, Di Leo G.

Citation:European Radiology. 2022 Mar;32(3):1611-1623.

Abstract:Objectives: Preoperative breast magnetic resonance imaging (MRI) can inform surgical planning but might cause overtreatment by increasing the mastectomy rate. The Multicenter International Prospective Analysis (MIPA) study investigated this controversial issue. Methods: This observational study enrolled women aged 18-80 years with biopsy-proven breast cancer, who underwent MRI in addition to conventional imaging (mammography and/or breast ultrasonography) or conventional imaging alone before surgery as routine practice at 27 centers. Exclusion criteria included planned neoadjuvant therapy, pregnancy, personal history of any cancer, and distant metastases. Results: Of 5896 analyzed patients, 2763 (46.9%) had conventional imaging only (noMRI group), and 3133 (53.1%) underwent MRI that was performed for diagnosis, screening, or unknown purposes in 692/3133 women (22.1%), with preoperative intent in 2441/3133 women (77.9%, MRI group). Patients in the MRI group were younger, had denser breasts, more cancers ≥ 20 mm, and a higher rate of invasive lobular histology than patients who underwent conventional imaging alone (p < 0.001 for all comparisons). Mastectomy was planned based on conventional imaging in 22.4% (MRI group) versus 14.4% (noMRI group) (p < 0.001). The additional planned mastectomy rate in the MRI group was 11.3%. The overall performed first- plus second-line mastectomy rate was 36.3% (MRI group) versus 18.0% (noMRI group) (p < 0.001). In women receiving conserving surgery, MRI group had a significantly lower reoperation rate (8.5% versus 11.7%, p < 0.001). Conclusions: Clinicians requested breast MRI for women with a higher a priori probability of receiving mastectomy. MRI was associated with 11.3% more mastectomies, and with 3.2% fewer reoperations in the breast conservation subgroup. Key points: • In 19% of patients of the MIPA study, breast MRI was performed for screening or diagnostic purposes. • The current patient selection to preoperative breast MRI implies an 11% increase in mastectomies, counterbalanced by a 3% reduction of the reoperation rate. • Data from the MIPA study can support discussion in tumor boards when preoperative MRI is under consideration and should be shared with patients to achieve informed decision-making.

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Cardiovascular disease morbidity is associated with social deprivation in subjects with familial hypercholesterolaemia (FH): a study comparing FH individuals in UK primary care and the UK Simon Broome register linked with secondary care records (2022)

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Type of publication:
Conference abstract

Author(s):
Iyen B.; Qureshi N.; Roderick P.; *Capps N.; Durrington P.N.; McDowell I.F.W.; Cegla J.; Soran H.; Schofield J.; Neil H.A.W.; Kai J.; Weng S.; Humphries S.E.

Citation:
Atherosclerosis Plus. Conference: HEART UK 35th Annual Medical & Scientific Conference. Virtual. 49(Supplement 1) (pp S4-S5), 2022. Date of Publication: October 2022

Abstract:
Background: Measures of social deprivation are associated with higher cardiovascular diseases (CVD) morbidity and mortality. To determine if this is also seen in subjects with Familial Hypercholesterolaemia (FH), CVD morbidity has been examined in participants in the UK primary care database (CPRD) and in the UK Simon Broome (SB) register using linkage to the UK secondary care Hospital Episodes Statistics (HES). Method(s): A composite CVD outcome was analysed (first HES outcome of coronary heart disease, myocardial infarction, stable or unstable angina, stroke, TIA, PVD, heart failure, PCI and CABG). The measure of socio-economic status/deprivation used was the English index of multiple deprivation (IMD). Cox proportional hazards regression estimated hazards ratios (HR) for incident CVD and mortality [95% CI] in each IMD quintile. <br/>Result(s): We identified 4,309 patients with FH in UK CPRD primary care database (followed from 1988 to 2020), free from CVD, and 2988 SB register participants, with linked secondary care HES records. In both groups, the prevalence of FH was considerably lower in the most deprived quintile (60% in CPRD and 52% in SB). CPRD patients in the most deprived quintile (IMD-5) had the highest prevalence of obesity and of smoking compared to those from IMD quintiles 1,2,3 and 4 (p-value for trend, all <0.001). Compared to least deprived, the most deprived individuals had the highest risk of composite CVD (unadjusted HR 1.71 [CI 1.22-2.40]), however, on adjustment for smoking and alcohol consumption, there were no statistical differences in CVD risk between socio-economic groups. In the FH Register patients there was an increase in the incidence rates and hazards ratios for composite CVD with increasing quintiles of deprivation. After adjustment for age, sex, smoking and alcohol consumption, this effect remained statistically significant (quintile 5 vs 1, HR = 1.83 [1.54-2.17]. Conclusion(s): Patients with FH are underdiagnosed in lower socio-economic groups. In both CPRD and the SB Register the most deprived FH patients had the highest risk of CVD and mortality, but in CPRD but not in the SB register this was largely explained by smoking and alcohol consumption. Clinicians should adopt more effective strategies to detect FH in lower socio-economic groups, and to optimise risk factor management and to support lifestyle changes and medication adherence for this group.

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To increase clinic capacity through the RSH pre-assessment department (2022)

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Type of publication:
Service improvement case study

Author(s):
*Rachael Bollands (Pre-Op Manager)

Citation:
SaTH Improvement Hub, 2022

Abstract:
The demand for a pre-operative assessment is growing and the current process results in many patients having to attend an additional appointment which is severely impacting on capacity. To overcome this, it was agreed to test out a “One-Stop Triage” process that would result in increasing capacity, while also improving patient satisfaction, which was extremely low. Following engagement with patients and colleagues, a new triage process was agreed and tested for 10 days. Following the trial, the data showed significant improvements to an increase to capacity, due to a decrease in additional appointments, while also significantly improving patient satisfaction. The aim now is to roll out the process to PRH and make this the new standard practice for our patients who require a pre-operative assessment.

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Neurological Observations (2022)

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Type of publication:
Service improvement case study

Author(s):
*Clare Walsgrove, *Leeanne Morgan, *Ward Managers

Citation:
SaTH Improvement Hub, May 2022

Abstract:
In order to maintain the overall health of our patients, it is important to monitor patients at risk of falls and the post fall care received.

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Rationalisation of Storeroom 2 in the Cataract Suite, RSH (2022)

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Type of publication:
Service improvement case study

Author(s):
*Sally Flukes (Ophthalmology Assistant ) and *Debbie Smith (Housekeeper)

Citation:
SaTH Improvement Hub, December 2022

Abstract:
To create a clutter free, safe and organised storeroom, which ensures the necessary equipment is stored in an appropriate place that makes it easily accessible for all colleagues, that meets the IPC standards as stated in the Trust policy by January 2023.

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Supporting Quality Improvement within the Stroke and Rehab Therapy Team (2022)

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Type of publication:
Service improvement case study

Author(s):
*Erin Tsang (Therapy Quality Improvement Lead)

Citation:
SaTH Improvement Hub, 2022

Abstract:
NHS Staff Survey results, staff listening events and informal feedback indicated reduced levels of staff engagement and opportunities for Quality Improvement within the inpatient therapy teams at PRH and RSH. Despite embedding national job planning initiatives within the Therapy Centre, staff reported feeling unable to take their allocated Supporting Professional Activities (SPA) time and felt unable to meet the conflicting demands of their job. A model of monthly Quality Improvement Half Day (QIHD) was trialed in October and November 2022 in the Stroke and Rehab Therapy team to offer therapy staff an opportunity for regular, protected SPA time as a whole team. As a result 90% of the team felt that the sessions allowed them to develop and demonstrate their leadership skills and the team were able to implement a number of service improvement projects.

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UEC Workstream 7- +21 day Lists (2022)

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Type of publication:
Service improvement case study

Author(s):
*Kirsty Sloan, *Lisa Brewin, *Jane Tait, *Dan Wilson, *Bev Adams, *David Bruce, *Madeleine Olive

Citation:
SaTH Improvement Hub, 2022

Abstract:
Following the Multi Agency Discharge Event in August 2022, one of the key successes was the reduction in the medically fit for discharge list. Following the debrief of the event the SaTH UEC Improvement Programme would like to explore how the number of patients who reside with SaTH for over 21 days can be reduced.

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Pharmacy Storeroom, PRH (2022)

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Type of publication:
Service improvement case study

Author(s):
*Kirsty Heathcock, *Imogen Brown

Citation:
SaTH Improvement Hub, October 2022

Abstract:
The pharmacy team noted that a store room area was cluttered and contained unnecessary equipment. Additionally, it was noted that there was a requirement for pharmacy students to have a dedicated study space. A study space was created for use during the 5S intervention.

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Radiology - Breast Screening (2022)

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Type of publication:
Service improvement case study

Author(s):
*Cat Rowlands (Programme Manager), *Lynn Rogers (Office Manager), *Jayne Edwards (Office Supervisor), *Mr Usman (Director of Breast Screening)

Citation:
SaTH Improvement Hub, December 2022

Abstract:
In order to reduce the backlog of breast screening appointments, the service was temporarily centralised at RSH and PRH. This reduced the backlog from 17,141 to zero.

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Urology Casenotes QIP (2022)

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Type of publication:
Service improvement case study

Author(s):
*Dr E. Mahon (FY2), *Mr J. O’Dair (Urology Consultant)

Citation:
SaTH Improvement Hub, 2022

Abstract:
Following an audit of medical documentation, it was found that the level of completion had declined from a previous audit. The aim of this QIP was to improve documentation standards within the Urology department in RSH, as measured by an improved audit score.

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